Good%20Governance%20for%20Medicines%20Programme:%20the%20Thai%20Experience

1
Good Governance for Medicines Programme the Thai
Experience

• Dr.Chanvit Tharathep.
• Director of HSSD Bureau, Department of HSS
• MOPH,Thailand

2
Medical Services in Thailand, in the year 2004
Priority
Hospitals Beds Out Patient Visits Inpatient Admission Inpatient days Bed occupancy rate ()
MoPH 875 86,667 80,596,859 6,015,238 25,892,528 82
MoP 2 748 69,963 21,146 146,765 54
MoF 1 82 106,810 1,738 18,741 63
MoC 1 120 39,683 1,667 14,967 34
MoI 1 80 15,740 3,290 9,022 31
MoJ 2 550 112,100 5,655 85,233 42
MoE 15 8,556 7,532,728 335,118 2,672,621 86
MoD 63 6,987 3,884,789 181,592 1,508,211 59
Autonomous 7 737 459,393 25,661 124,285 46
Local Authority 13 2,375 2,322,571 109,233 599,207 69
Private 298 26,343 29,346,824 1,601,497 4,602,531 48
Total 1,278 133,245 124,487,460 8,301,835 35,674,111 73
Source Bureau of Strategy and Policy, MoPH,
Thailand 2006
3
MOPH
Professional Council
National Health Security Committee
Office Of Permanent Secretary
Office Of Minister
National Health Security Office
Drug Quality
Medical Service Cluster
Public Health Cluster
Health Service Support Cluster
Pharmaceutical Procurement, Management
Department of Medical Science
Department of Disease control
Department of Medicine
Department of Health
Department of Mental Health
Department of Health Service Support
Department of Thai Traditional Development and
Alternative Medicine
Pharmaceutical registration, Selection
FDA
Provincial Health Offices
Health Centers
Public Hospitals Autonomous
4
Number of beneficiaries and percentage of health
care security by scheme in the year 2007
Benefit Package Includes Pharmaceutical products
Health Security Scheme Number of beneficiaries Percentage of coverage
UC 46,636,899 73.49
SSS 9,060,033 14.28
CSMBS 5,119,535 8.07
Unidentified groups 2,640,356 4.16
Total 63,456,823 100
No Coverage, Drug Store
Source IT Department, National Health Security
Office, April, 2007
5
Existing GGM infrastructure transparency and
accountability in Thailand

• National Drug Policy 1981, 1993
• Safety, Quality, Appropriate Price, Access
• Essential Drugs list 1981-2008, Standard Price
  (2008)
• Public Good Governance Law 2004
• Drug management Reform 1997-2008 in MoPH
  hospitals
• Group purchasing of drugs and medical supplies.
• Limiting numbers of Drug items, emphasizing uses
  of drugs in national essential drugs list.
• Control of Drug Inventory Level to be 3-month
  supply or less.
• Purchasing and Management performing under
  committee basis (Pharmaceutical)
• Reporting system.
• Setting up MoPH Pharmacy Information Center.
• Situation Analysis, Strategic Formulation,
  Transfer to operation

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Phase I Transparency assessment
Area Total Questions (Sub-Questions) Scale of 10 Degree
Registration 18 (45) 7.0 Marginally vulnerable
Selection 14 (29) 8.0 Marginally vulnerable
Procurement 22 (50) 7.1 Marginally vulnerable
Rating Score
0.0-2.0 2.1-4.1 4.1-6.0 6.1-8.0 8.1-10.0
Extremely vulnerable Very vulnerable Moderately vulnerable Marginally vulnerable Minimally vulnerable
Assess system vulnerability to unethical
practices by external peers.
7
Phase I Transparency assessment

• 6 months interval, MoPH Inspection
• FDA essential drug selection accessible via
  internet
• MoPH Hospitals purchasing report to the Public
  accessible Pharmacy Information Center.

Hospital type 2004 2005 2006
Regional hospitals 21 24 25
General hospitals 62 70 69
Community hospitals 569 667 645
Total 659 765 742
Source Pharmacy Information Center, MoPH,
Thailand 2007
8
Phase II. Development of Thai GGM Flamework and
Strategic plan

• Moral values and ethical principles
• Self Sufficiency principle (King Bhumipol),
  Middle Path (Buddhist), Transparency policy
• A code of conduct Civil Servant Act 1989
• Socialization of an ethical framework and code of
  conduct
• Established anti-corruption legislation
• Anti-corruption Act 1999, Public Good Governance
  Royal Decree 2004, National Anti-corruption
  Organization
• Established administrative procedures
• MoPH Policy, Guidelines, Meeting, Conflict of
  interest form, Cirriculum
• Mechanisms for whistle-blowing (ombudsman)
  Website, One Stop Service
• Sanctions on reprehensible acts
• National Anti-corruption organization, MoPH
  Disciplinary Office
• Mechanisms for collaboration between existing
  anti-corruption agencies
• Anti-corruption Act 1999, Public Good Governance
  Royal Decree 2004
• Carbinet approved guideline and recommendation
• Management, coordination and evaluation of an GGM
  framework

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GGM Strategic Formulation
Develop Policy Guidelines National
Networking Strengthen Information
Database Dissemination of Ethical Practice
Information Assessment

• Ethical Framework, legislation, Policy
• Practice Guidelines, Medicine Promotion Practice
  criteria
• Standard of Practice (SOP)
• Declare Consent form, Conflict of interest form
• FDA, DHSS, DMS, Universities, Professional
  Councils
• Hospital Pharmacy Association
• Community Pharmacy Association
• PREMA,
• Thai Pharmaceutical Manufacturer Association
• NGOs
• Selection, Registration
• Procurement
• Drug Price, Drug Promotion Practice
• Research, Study and cases
• Public accessible Pharmacy Information Center
• Meeting, News Letter
• Webpage of Good Governance
• Best Practice
• Interested Working Group

10
Phase III Implementation Phase
Develop Policy Guidelines National
Networking Strengthen Information
Database Dissemination of Ethical Practice
Information Assessment

• Ethical Framework, legislation, Policy
• Practice Guidelines, Medicine Promotion Practice
  criteria
• Standard of Practice (SOP)
• Declare Consent form, Conflict of interest form
  (ED, SP)
• FDA, DHSS, DMS, Universities, Professional
  Councils
• Hospital Pharmacy Association
• Community Pharmacy Association
• PReMA,
• Thai Pharmaceutical Manufacturer Association
• NGOs
• Selection, Registration
• Procurement
• Drug Price, Drug Promotion Practice
• Research, Study and cases
• Public accessible Pharmacy Information Center
  (English)
• Meeting
• Newsletter, Webpage of Good Governance
• Best Practice
• Interested Working Group

11
Publications/medias provided (contd)

• News Letter, Electronic data and information on
  CDs, Website http//dmsic.moph.go.th

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Changes and Impacts
Increased Awareness More Transparency More
Efficiency Networking Learning Process
Assessment
GGM Flamework
GGM Implementation
2004-2005
2005-2006
Oct 2006-2008
Situation Analysis
Thai GGM Strategy
More Transparency By Information
Existing GGM Infrastructure strengthening
Available Practices, Guidelines
Registration, Selection, Procurement Improvement
GGM Networking
Forms, Procedures
Socialization, Education.
Strengthening Anti-Corruption Laws, Agency and
Mechanism, Moral Value and Ethical Principles
13
GGM Framework in Registration, Selection,
Procurement

• Registration Conflict of interest form
  implementation,
• Selection Conflict of interest form, Guideline,
  Code of Conduct, Transparency.
• Procurement Guideline, Code of Conduct, Manual,
  Regulation, Transparency.
• Socialization- Increase awareness, Introduction
  of the GGM into Education.

14
More Transparent
15

• Evidence of More Efficiency

Drug item Pack unit Average price Average price Average price
Drug item Pack unit Regular Separated purchasing Provincial group purchasing Regional group purchasing
Diclofenac tab 25 mg 500 107.86 74.69 57.38
Insulin Human Base vial 100 IU/ml (10 ml) 1 308.99 300.63 310.30
Medroxyprogesterone amp. 50 mg/ml (3 ml) 1 16.08 12.49 13.50
Ranitidine tab 150 mg 500 200.95 201.34 177.62
Salbutamol inhaler 100 mcg (200 doses) 1 105.93 112.68 139.10
Salbutamol sol 0.5 (20 ml) 1 91.87 102.44 85.60
Source Pharmacy Information Center, MoPH,
Thailand 2007
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What has worked and what should be redisign.

• Information System for Continuous Assessment and
  evaluation would be helpful.
• Good Governance can be achieved by committee
  basis for decision making.
• Conflict of Interest declaration can be
  implemented in the Selection of EDL 2007-2008.
• Selective Group Purchasing is a good tool to
  control drug price.

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Lessons learnt to date

• GGM Framework is the national level management.
  We should realize that different country is
  different context..
• Health care environment should be evaluated and
  priority setting should be done at first step.
• The strategy should be formulated to support and
  transfer into operation.
• Transparency is the most effective, efficient and
  feasible for the first step of good governance
  implementation. We can achieve transparency with
  the Pharmacy Information center.

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Recommendations
First
Second
National GGM Framework development
Third
Health care environment Analysis
Target Priority Setting
Strategic formulation
Information
Networking
Socialization
Guideline
Fourth
Operation
Information System
Transparency
Intervention
Assessment
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Conclusion

• Health Service System in Thailand and the MoPH
  structure.
• Transparency and increase accountability policy
  in Thailand
• The 3 phases of Good Governance for medicines
  programme implementation in Thailand.
• Changes and Impacts.
• Lessons learn and recommendation.